Tricare Help: Can I join Guard to cover pregnant wife?

Sep. 25, 2013 - 05:11PM
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Q. My wife is 10 weeks pregnant and has found that her health plan does not cover maternity care. We make too much money for public assistance. I am not in the military, but I know Tricare places no restrictions on pre-existing conditions. If I enlist in the National Guard, can I get her covered for the remainder of the pregnancy and the delivery? I have contacted a recruiter.

A. Yes, you can get Tricare coverage for your wife’s maternity care by enlisting in the National Guard. But it would not be free; as a drilling guardsman, you would be eligible only for Tricare Reserve Select, which requires enrollment and payment of monthly premiums. You would be eligible for free health care coverage under Tricare Prime and Tricare Standard only if you are mobilized for active duty for more than 30 days. The current Tricare Reserve Select premium is $195.81 per month for family coverage, and you must submit an initial two-month premium payment with your application form to activate coverage.

Q. I will be 65 in three months. An HMO broker told me that if I get a Medicare Part C HMO plan, I will lose my Tricare for Life. Is that true? Also, he ad­vised me to sign up for Medicare Part D. Should I?

A.You should consider very carefully whether a Medicare Part C plan is right for you. Should you go with one, you will NOT lose eligibility for Tricare for Life; how your health care is paid for will simply work slightly differently. The Part C company would provide your Part A and B benefits, and you would still pay your regular Part B premiums, plus possibly an additional premium to the Part C company. Since you would still be paying Part B premiums, which is the bedrock requirement for Tricare for Life eligibility, you would not be shut out of Tricare.

However, most beneficiaries who are eligible for Tricare for Life don’t need a Part C plan because the components of Tricare for Life — Medicare parts A and B plus Tricare Standard — will cover 100 percent of a beneficiary’s medical bills on the vast majority of claims. With that said, some Part C plans offer additional coverage not available under regular Medicare parts A and B or Tricare Standard, such as routine vision and hearing exams, as well as eyeglasses and hearing aids.

What you definitely don’t need is Medicare Part D. If you sign up for Part D, you would have to file separate claims with Tricare to be reimbursed for the Part D plan’s drug co-payments and deductibles, and you would not be able to use Tricare’s mail-order pharmacy. Note that some Medicare Part C plans require enrollees to sign up for Medicare Part D as an integral part of the “package.” Be sure to ask the person you’ve been talking to if the Part C plan he is trying to sell you requires Part D enrollment, or whether Part D enrollment is separate and voluntary.